Jaiswal Vikash, Khan Nida, Jaiswal Akash, Dagar Mehak, Joshi Amey, Huang Helen, Naz Hira, Attia Abdelrahman M, Ghanim Mohammed, Baburaj Abiram, Song David
Department of Cardiovascular Research, Larkin Community Hospital, FL, USA.
Jinnah Sindh Medical University, Karachi, Pakistan.
Int J Cardiol Heart Vasc. 2022 Sep 22;43:101125. doi: 10.1016/j.ijcha.2022.101125. eCollection 2022 Dec.
Although aortic valve replacement in severe symptomatic Aortic Stenosis (AS) are clearly outlined, the role of surgical intervention in asymptomatic severe AS remains unclear with limited evidence. The aim of our meta-analysis is to evaluate the efficacy and safety of early surgical aortic valve repair compared to conservative management.
A systematic literature search was performed in PubMed, Scopus, Embase and Cochrane databases for studies comparing the early surgery versus conservative management among asymptomatic aortic stenosis patients. Unadjusted odds ratios (OR) were pooled using a random-effect model, and a p-value of < 0.05 was considered statistically significant.
A total of 5 articles (3 observational studies and 2 randomized controlled trials) were included. At a median followup of 4.1 years, here were significantly lower odds of all-cause mortality [OR = 0.30 (95 %CI:0.17-0.53), p < 0.0001], cardiovascular mortality [OR = 0.35 (95 %CI:(0.17-0.72), p = 0.005], and sudden cardiac death (OR = 0.36 (95 %CI: 0.15-0.89), p = 0.03) among early surgery group compared with conservative care. There was no significant difference between incidence of major bleeding, clinical thromboembolic events, hospitalization due to heart failure, stroke and myocardial infarction between the conservative care groups and early surgery.
Among asymptomatic patients with AS, early surgery shows better outcomes in reducing all-cause mortality and cardiovascular mortality compared with conservative management approaches.
虽然重度症状性主动脉瓣狭窄（AS）患者进行主动脉瓣置换术的情况已明确，但无症状重度AS患者手术干预的作用仍不明确，证据有限。我们进行这项荟萃分析的目的是评估早期手术主动脉瓣修复与保守治疗相比的疗效和安全性。
在PubMed、Scopus、Embase和Cochrane数据库中进行系统文献检索，以查找比较无症状主动脉瓣狭窄患者早期手术与保守治疗的研究。使用随机效应模型汇总未调整的优势比（OR），p值<0.05被认为具有统计学意义。
共纳入5篇文章（3项观察性研究和2项随机对照试验）。在中位随访4.1年时，与保守治疗相比，早期手术组全因死亡率[OR = 0.30（95%CI：0.17 - 0.53），p < 0.0001]、心血管死亡率[OR = 0.35（95%CI：0.17 - 0.72），p = 0.005]和心源性猝死（OR = 0.36（95%CI：0.15 - 0.89），p = 0.03）的优势比显著更低。保守治疗组和早期手术组在大出血发生率、临床血栓栓塞事件、因心力衰竭住院、中风和心肌梗死方面无显著差异。
在无症状AS患者中，与保守治疗方法相比，早期手术在降低全因死亡率和心血管死亡率方面显示出更好的结果。
